Business KYC

Please complete ALL details in this form

CORPORATE IDENTITY

Company Name *

Income Tax Number

VAT Registration Number (if applicable)

Email Address *

Website

Phone *

Fax *

If External Head Office Address

Unit

City

Country

Botswana Citizen / Permanent Resident?

Postal Address

Nationality

REGULATORY INFORMATION

Certiﬁcate of Registration No.: *

Country of Incorporation

License no.

Expiry Date

CONTACT PERSON

Prefix

First Name

Middle Name

Last Name

Capacity / Position

Plot Number

Ward /Locality

City

Postal Address

Country

Date of Birth

Nationality

National ID /Passport Number *

Email Address *

Phone *

Fax Number

Brief description of business

Source of income

Annual Turnover *Below P1MillonAbove P1Millon

BENEFICIAL OWNERSHIPDECLARATION OF BENEFICIAL OWNERSHIP The Company hereby confirms and declares that as at the date hereof,The following individual(s) is/are the ultimate principal beneficial owner(s) of the Company through ownership in the intermediate or ultimate holding companies:

Prefix

First Name *

Middle Name

Last Name *

Residential Address

Date of Birth

Nationality

Ownership (%)

BANKING DETAILS

Bank

Account Number *

Branch *

Branch Code *

DECLARATION

ANTI-MONEY LAUNDERING AND COUNTER TERRORIST FINANCING REQUIREMENTS

n accordance with the Financial Intelligence Regulations, the following documents should be provided for verification:

Natural Persons
Identification document e.g. Certified copy of I.D / Passport

Company
Certificate of incorporation
Memorandum and Articles of Association
Notice of Registered Office and Postal Address
Identification documents of the person(s) managing the company
Resolution specifying who is authorised to act on behalf of the company
Identification document(s) of the person(s) authorised to act on behalf of the company

Partnerships
Partnership agreement
Identification documents of the natural persons who are partners e.g. Certified copy of I.D / Passport
Resolution specifying who is authorised to act on behalf of the partnership
Identification document(s) of the person(s) authorised to act on behalf of the partnership

Date *

Place